Clinical markers of hyperandrogenism and response to conventional antibiotic therapy in women with acne vulgaris (original) (raw)
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The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms – a review
The European Journal of Contraception & Reproductive Health Care, 2017
Introduction: Hyperandrogenism affects approximately 10-20% of women of reproductive age. Hyperandrogenic skin symptoms such as hirsutism, acne, seborrhea and alopecia are associated with significant quality of life and psychological impairment. Women with abnormalities in androgen metabolism may have accompanying anovulation and/or polycystic ovary syndrome (PCOS), both of which have reproductive and metabolic implications if left untreated. Cyproterone acetate (CPA), combined with ethinylestradiol (EE), is indicated for the treatment of moderate to severe acne related to androgen-sensitivity (with or without seborrhea) and/or hirsutism, in women of reproductive age. Objective: To review the data on the efficacy and safety of CPA 2 mg/EE 35 lg for the treatment of hyperandrogenic skin symptoms in women. Methods: A non-systematic narrative review based on a literature search of the PubMed database. Results: Seventy-eight studies were identified. The majority of sufficiently powered studies show a high efficacy of CPA 2 mg/EE 35 lg in the treatment of severe acne and hirsutism. Studies show that therapeutic response in women with hirsutism requires a long-term approach and that hyperandrogenic skin symptoms in patients with PCOS are efficiently treated. Additional benefits include cycle control and, in some women, improvement in mood and perception of body image. Safety and tolerability data are summarized by the pharmacovigilance risk assessment committee (PRAC) of the European Medicine's Agency's (EMA). Conclusions: This review provides a comprehensive overview about the efficacy of CPA 2 mg/EE 35 lg in the treatment of hyperandrogenic skin symptoms, thus allowing both health care professionals and women to balance the risks and benefits of treatment based on evidence.
Androgen Dependence of Hirsutism, Acne, and Alopecia in Women
Medicine, 2009
Hirsutism, acne, alopecia, and oligo-amenorrhea are clinical expressions of hyperandrogenism, one of the most frequent endocrine disorders in women of reproductive age. Women referred to our endocrine clinics for skin symptoms of hyperandrogenism underwent a laboratory workup to evaluate hormone measurements and received antiandrogen therapy. We retrospectively analyzed the outcome of 228 consecutive patients investigated over 6 years. Patients with hirsutism had higher levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), and salivary testosterone; lower levels of sex hormone-binding globulin (SHBG); and a higher prevalence of oligo-amenorrhea than patients with alopecia, while patients with acne showed intermediate values. Hirsutism score correlated positively with androstenedione, DHEAS, and salivary testosterone, and correlated negatively with SHBG; salivary testosterone showed the highest correlation coefficient. Total testosterone was not significantly different among patients with hirsutism, alopecia, or acne, and did not significantly correlate with hirsutism score. Hirsutism and oligo-amenorrhea were the most sensitive symptoms of hyperandrogenism, and no androgenic parameter alone allowed us to identify all cases of hyperandrogenism. Patients of central European origin sought consultation with milder hirsutism scores than patients of southern European origin. There was, however, no difference in the clinical-biological correlation between these groups, arguing against differences in skin sensitivity to androgens. Polycystic ovary syndrome, defined as hyperandrogenism (hirsutism or elevated androgens) and oligo-amenorrhea, was diagnosed in 63 patients (27.6%), an underestimate compared with other reports that include systematic ovarian ultrasound studies. Neither pelvic ultrasound, used in a limited number of cases, nor the luteinizing hormone/folliclestimulating hormone ratio helped to distinguish patients with polycystic ovary syndrome from the other diagnostic groups. These included hyperandrogenism (hirsutism or elevated androgens) and eumenorrhea (101 patients; 44.3%); normal androgens (acne or alopecia and eumenorrhea) (51 patients; 22.4%); isolated low SHBG (7 patients; 3.1%); nonclassical congenital adrenal hyperplasia (4 patients; 1.8% of total, 4.9% of patients undergoing cosyntropin stimulation tests); and ovarian tumor (2 patients; 0.9%). Ethinylestradiol and high-dose cyproterone acetate treatment lowered the hirsutism score to 53.5% of baseline at 1 year, and was also effective in treating acne and alopecia. The clinical benefit is ascribed to the peripheral antiandrogenic effect of cyproterone acetate as well as the hormone-suppressive effect of this combination. Salivary testosterone showed the most marked proportional decrease of all the androgens under treatment. Cost-effectiveness and tolerance of ethinylestradiol and high-dose cyproterone acetate compared well with other antiandrogenic drug therapies for hirsutism. The less potent therapy with spironolactone only, a peripheral antiandrogen without hormone-suppressive effect, was effective in treating isolated alopecia in patients with normal androgens.
Treatment of hyperandrogenic alopecia in women
Fertility and Sterility, 2003
To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia. Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients. Endocrinologic outpatient practice in Italy. A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels. Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year. Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness. Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend. Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.
Systemic cyproterone acetate and 5% minoxidil topical in the treatment of female pattern hair loss
2016
Objective To assess the efficacy and safety of systemic cyproterone acetate and 5%topical minoxidil solution in female pattern hair loss (FPHL). Patients and methods This was a six month open trial of 2mg cyproterone acetate and 35µg ethinyl estradiol (Diane35®) for 21 days of each cycle and 50 mg cyproterone acetate for 10 days along with diane35 and 5%topical minoxidil,1ml twice daily for all days of treatment. Study was conducted on out patients at Abassi Shaheed Hospital/ Aga Khan Hospital, Karachi. 26 females with FPHL were included in the study. Results At six months, compared with base line there was a statistically significant improvement in hair growth/decrease or no loss of hair reported. Both treatment regimens were well tolerated. There was no progression of FPHL in all patients. Conclusion Systemic cyproterone acetate and 5%topical minoxidil are effective and safe in FPHL.
Anti-androgen treatment in women with acne: a controlled trial
British Journal of Dermatology, 1986
Ninety female patients with acne were allocated randomly to one of three groups and treated either with Diane, a high dose cyproterone acetate (CPA) regime with ethinyloestradiol, or Minovlar. The same dose of oestrogen was common to all three treatment groups.
Dermatologic Therapy, 2021
Androgenic alopecia (AGA) is a common and chronic condition. It may impact selfesteem, self-image and quality of life. Benefit, tolerability, cosmetic acceptance and patient satisfaction are key to ensure good treatment outcome. Hair loss improvement and hair quality with AC5 (2,4-Diamino-Pyrimidine-N-Oxyde, arginine, 6-O glucose linoleate (SP94), piroctone olamine and Vichy mineralizing water) once daily was assessed in 527 subjects with mild AGA in an open-label, observational, international real-life study. After 3 months, investigators evaluated the impact of AC5 on hair loss, product satisfaction and asked subjects about local tolerance; subjects assessed hair growth and quality and satisfaction. Data from 357 subjects were evaluable for the benefit analysis; 59.9% of subjects were female; the mean age was 33.6±8.7 years. Duration of hair loss was 1.62±2.24 years. 71.3% of women had a Ludwig score of 1 and 40.8% of men had a Hamilton Norwood score of 2. At the end of study, hair loss was reduced in 89.0% of subjects; it was slightly higher in women (92.5%) than in men (83.8%). Subject satisfaction on a scale from 0 (not satisfied at all) to 10 (completely satisfied) was 7.9±1.7. Tolerance was rated good to very good by 98.6% of all subjects. In conclusion, AC5 reduces mild AGA in both men and women with a pleasant texture. AC5 was well tolerated and highly appreciated.
JAMA Dermatology, 2022
IMPORTANCE There are knowledge gaps regarding the relative efficacy of 3 commonly used drugs for androgenetic alopecia (AGA), namely, minoxidil and the two 5-α reductase inhibitors dutasteride and finasteride. OBJECTIVE To examine the relative efficacy of any dose and administration route of minoxidil, dutasteride, and finasteride for the treatment of male AGA. DATA SOURCES Systematic searches were performed in PubMed on March 5, 2021, without date restrictions. STUDY SELECTION Eligible studies included those that investigated monotherapy with any dose and administration route of minoxidil, dutasteride, and finasteride. DATA EXTRACTION AND SYNTHESIS Data on the mean (SD) difference and sample size were used for the bayesian network meta-analyses. League tables and surface under the cumulative ranking curve values were used to examine the relative efficacy of the interventions. MAIN OUTCOMES AND MEASURES Study end points were change in total and terminal hair count after 24 and 48 weeks of therapy. The 4 end points were quantified in hairs per square centimeters. RESULTS The PubMed search yielded 848 records; after the 2 stages of screening, 23 studies were eligible for quantitative analyses. Mean (SD) age of patients ranged from 22.8 (3.3) years to 41.8 (12.3) years. The greatest increase in total hair count at 24 weeks (ie, first end point) was with 0.5 mg/d of dutasteride, which was significantly more efficacious than 1 mg/d of finasteride (mean difference, 7.1 hairs/cm 2 ; 95% CI, 5.1-9.3 hairs/cm 2) and minoxidil (0.25 mg/d [mean difference, 23.7 hairs/cm 2 ; 95% CI, 9.5-38.0 hairs/cm 2 ], 5 mg/d [mean difference, 15.0 hairs/cm 2 ; 95% CI, 3.9-26.1 hairs/cm 2 ], and 2% solution [mean difference, 8.5 hairs/cm 2 ; 95% CI, 4.8-12.3 hairs/cm 2 ]). The greatest increase in terminal hair count at 24 weeks (ie, second end point) was with 5 mg/d of minoxidil, which was significantly more efficacious than the 0.25-mg/d dose (mean difference, 43.6 hairs/cm 2 ; 95% CI, 29.7-57.7 hairs/cm 2) and its topical forms (in 2% [mean difference, 29.3 hairs/cm 2 ; 95% CI, 21.1-37.5 hairs/cm 2 ] and 5% [mean difference, 29.8 hairs/cm 2 ; 95% CI, 19.7-39.8 hairs/cm 2 ]); 5 mg/d of minoxidil was significantly more efficacious than 1 mg/d of finasteride (mean difference, 10.4 hairs/cm 2 ; 95% CI, 2.2-18.6 hairs/cm 2). The greatest increase in total hair count at 48 weeks (ie, third end point) was with 5 mg/d of finasteride, which was significantly more efficacious than 2% topical minoxidil (mean difference, 20.7 hairs/cm 2 ; 95% CI, 9.5-31.9 hairs/cm 2). The greatest increase in terminal hair count at 48 weeks (ie, fourth end point) was with 1 mg/d of finasteride, which was significantly more effective than topical minoxidil (in 2% [mean difference, 32.1 hairs/cm 2 ; 95% CI, 23.9-40.3 hairs/cm 2 ] and 5% [mean difference, 26.2 hairs/cm 2 ; 95% CI, 16.2-36.2 hairs/cm 2 ]). CONCLUSIONS AND RELEVANCE As efficacy data from head-to-head trials accumulate, there could be a better sense of the relative efficacy of the different doses of the 5-α reductase inhibitors and minoxidil. The findings of this meta-analysis contribute to the comparative effectiveness literature for AGA therapies with regard to the compared interventions.
Efficacy of Off-Label Topical Treatments for the Management of Androgenetic Alopecia: A Review
Clinical Drug Investigation, 2019
Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treatment of AGA in men. A literature search was conducted to obtain randomized, controlled and blinded studies that investigated off-label, topical, monotherapies in male patients. Hair density, hair diameter and hair growth were used to evaluate treatment success. Fourteen off-label topical therapies were investigated among the 16 studies that met inclusion criteria. Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g., mean change from hair count and hair diameter) as compared to placebo (p<0.05 for all treatments). In two studies, procyanidin oligomers exhibited greater efficacy over vehicle with response to mean change in hair density (hairs/cm 2) (p s < 0.0001 at week 24). In conclusion, prostaglandin analogs and polyphenols, such as latanoprost and procyanidin oligomers, can improve hair restoration parameters in male AGA patients, possibly through targeting mechanisms proposed in the etiology of AGA. The current evidence suggests short term (24 weeks) use may provide benefit for hair loss patients; however, long-term efficacy and safety data are required.
The Effect of a Food Supplement and a Hair Lotion on the Progression of Androgenetic Alopecia
Journal of Cosmetics, Dermatological Sciences and Applications
Background: Progressing androgenetic alopecia (AGA), in both sexes, can result in severe distress. Treatments with the capacity to slow down the progression of AGA, or even to bring it to a halt, and at the same time don't come with side effects are consequently highly sought for. Therefore this study investigates the effect of an over-the-counter nutritional supplement and a similarly formulated topical hair lotion on the progression of AGA. Methods: Seventy-nine healthy study participants of both sexes, who were diagnosed with AGA were divided into 4 study groups. The subjects of the first group were treated with the nutritional supplement, the subjects of the second group with the topical hair lotion, the subjects of the third group with both products, and the subjects of the fourth group served as a no-treatment control. At the beginning and at the end of this nine-month study, the participants were evaluated for their hair loss status. They also answered a questionnaire for self-assessment. A part of the subjects from each study group were further analysed by phototrichography, in order to measure the number of anagen and telogen hairs. Results: It turned out that the supplement, the lotion as well as the treatment with both products not only lead to a reduction in hair loss but also to an increased anagen to telogen hair ratio, whereas no such effects could be measured for the control group. Conclusion: The results show that a systemic delivery via a nutritional supplement, as well as a follicular delivery via a topically applied lotion, both resulted in a reduced hair loss rate as well as in an increased anagen to telogen hair ratio. This demonstrates that the tested formulation is effectively slowing down the progression of AGA.